How does the proctologist treat?
Proven: Sclerotherapy and rubber band ligature
This treatment without surgery has the aim of tightening and stabilizing the connective tissue. During the so-called sclerosing, a drug (Ethoxysklerol®) is injected into the area of the vessels leading to the hemorrhoids or into the hemorrhoids themselves, which shrinks them and strengthens the anchoring on the muscle layer of the rectum. This measure can easily be performed on an outpatient basis, is painless and is therefore used very frequently. As a rule, it must take place several times at intervals of a few weeks. It can take from a few months to a few years for the symptoms to disappear completely. Complications are extremely rare.
With the rubber band ligature, excess mucous membrane is tied off with a rubber ring, the tissue repels itself after one to two weeks. This reduces the size of the haemorrhoids and fixes them in their natural position by scarring. This measure must also not cause any pain, otherwise a different method of treatment must be chosen.
Bleeding or post-operative bleeding are risks, especially if you are taking blood-thinning medications. The tied tissue can be uncomfortable until it is rejected, so it is advisable not to put more than one or two bands in one treatment session.
In patients with chronic inflammatory bowel diseases (Crohn's disease, ulcerative colitis), a weakened immune system or a latex allergy, ligation is not the best treatment option.
Innovative: Non-invasive sclerotherapy with LASER
A new approach to hemorrhoid treatment is the use of medium energy laser energy, which strengthens the connective tissue and shrinks the hemorrhoids, but remains below the pain threshold. The practical implementation is comparable to sclerotherapy. We perform this treatment on an outpatient basis using a proctoscopy with a local anaesthetic gel, an anaesthetic is not required. Our experience with this technique is very good, especially persistent bleeding often responds well to this treatment.
Hemorrhoid surgery with the Circular Stapler (Longo surgery)
A strip of mucous membrane is removed above the haemorrhoid base over the entire circumference of the haemorrhoid base and the mucous membrane is then reunited using a stapler. This reduces the blood flow to the haemorrhoids as well as reducing the prolapse (hence the term stacker - haemorrhoidopexy, "fortification"). The clamps heal into the scar or are gradually rejected. The procedure is widely used due to its short operation time and painless after-treatment. After hundreds of successful haemorrhoid operations, we still do not use this procedure any more, after rare but serious incidents have been reported in publications (rupture of the staple seam, intolerance of the staples).
Surgical therapies: Treating haemorrhoids with laser
If the disease has progressed too far or the conservative therapy methods have not led to success, haemorrhoids can be treated by laser. These include laser haemorrhoidectomy, laser haemorrhoidoplasty and haemorrhoid artery ligation.
If you are interested in a treatment of your haemorrhoids in our proctological centre in Munich, Dr. Hofer and Mr. Bärtl are at your disposal for all questions. Give us a call, we are here for you.